Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

Abstract: The giant ovarian teratoma is a neoplasm that can be benign or malignant according to its histological type. These tumors will be classified as mature or benign and immature or malignant, and their treatment and prognosis will depend on it. The aim of this work is to present a clinical case of giant teratoma of ovary, its diagnosis and treatmentMaterials and methods: a qualitative, descriptive study was performed; clinical case presentation of a giant ovarian teratoma. Relevant aspects of this neoplasia and the importance of timely diagnosis are described. Authorization was obtained from the teaching and research department of the Alfredo G Paulson Hospital, allowing the review of clinical history and images, for the publication of the present case. Results: the case of a 31-year-old female patient presented with a large palpable abdominal mass, accompanied by pain in the left iliac fossa, which radiates to the lower limb on the same side Surgical treatment is provided by performing total abdominal hysterectomy, left salpingo-oophorectomy, right ovary wedge resection, omentectomy, and adhesiolysis; a left appendage tumor of 26 x 20 x 15 cm is obtained, whose histopathological diagnosis was reported: Grade 2 immature teratoma in left ovary. Conclusions: Ovarian teratoma should be diagnosed early, despite its non-specific signs and symptoms; if it is a mature teratoma in young people or adolescents, conservative surgical treatment with cystectomy and periodic annual follow-up is recommended, if it is an immature teratoma according to its stage, we will proceed to accompany the surgical treatment of total oophorectomy salpingo with adjuvant chemotherapy. The prognosis of the teratoma is generally good, since 80% of cases are of benign origin, however, there is a small percentage of risk of transformation to malignant, so it is a pathology of great care, control and interest.

Introduction: Tracheomalacia in critical care is a rare entity in the adult population, so we present two relevant clinical cases, where a striking deformity of the trachea was evident. In the first case, concomitantly with other diseases such as thyroid pathologies (goiter) and in the second case as a result of severe burns, product of the explosion of a gas canister for domestic use. Objective: to describe two clinical cases of patients with tracheomalacia in critical care unit and to recognize the main diagnostic and therapeutic methods. Materials and methods: a retrospective descriptive study was performed, presentation of 2 clinical cases, with a diagnosis of tracheomalacia in the critical care unit; institutional informed consent was requested for review of clinical histories of the patients studied and publication of the respective images. Discussion: The main signs and symptoms in both clinical cases were dyspnea, hypoxemia and failure of extubation. In the first clinical case, the diagnosis of tracheomalacia, was found during surgery for exeresis of thyroid tumor, in the second case the diagnosis was made by fibrobronchoscopy and anatomical loss was observed in the normal way, cylindrical of the trachea. With regard to treatment, it should be emphasized that tracheal surgery and the development of endoluminal tracheal prostheses currently represent a great therapeutic alternative. Conclusions: tracheomalacia can cause serious changes in oxygenation so it is important to recognize, diagnose and treat this pathology in a timely manner, as it represents a high comorbidity in the critical patient, which increases the need for reintubation and increases failure in disconnecting mechanical ventilation.

Introducción: Las enfermedades mentales en los profesionales de la salud, especialmente en médicos y enfermeras actualmente son de especial preocupación, por la alta frecuencia con la que ocurren y por el impacto que estas tienen en la calidad de vida del profesional y en la calidad de la atención al paciente. Objetivo general: Determinar los problemas de salud mental en médicos y enfermeras de áreas críticas (Emergencia y Unidad de Cuidados Intensivos) del Hospital General Puyo, en el primer semestre del año 2022. Metodología: Estudio observacional, analítico de corte transversal, con una muestra de 59 profesionales médicos y enfermeras a los cuales se aplicó la Escala de ansiedad y depresión de Goldberg y el Cuestionario de Maslach Burnout Inventory. Los datos se analizaron con el programa SPSS v15 mediante estadística descriptiva y se determinó asociación con la prueba chi cuadrado de Pearson, se consideró resultados estadísticamente significativos a los valores de p<0.05. Resultados:  se encontró que la prevalencia de ansiedad es del 84.7%, depresión del 72.9% y la de Burnout del 69.5%. Según las dimensiones del Burnout se identificó afectación de la dimensión realización personal en 55.9%, dimensión despersonalización 100% y dimensión agotamiento o cansancio emocional en el 69.5%. Los grupos más afectados son los que tienen entre 30-34 años, solteros, mujeres, en quienes laboran en el área de emergencia, y consumen alcohol. Conclusiones: la frecuencia con la que ocurren problemas de salud mental en el personal de salud del Hospital General Puyo es alta, lo cual debería ser motivo de preocupación y de acciones inmediatas para prevenir y tratar de manera oportuna estos trastornos para mejorar la calidad de vida del personal y la calidad de la atención al paciente.

Introduction: Noonan syndrome (NS) is a genetic disorder of autosomal dominant inheritance. It is characterized by a classic triad: very characteristic craniofacial features, short stature and congenital cardiovascular anomalies. The genetic alteration occurs in genes encoding proteins involved in the intracellular signaling pathway of RAS-MAPKs (mitogen-activated protein kinases), usually the mutation occurs in 4 genes. The clinical manifestations are varied and multisystemic. It is closely related to multiple lentiginosis, Costello syndrome and cardiofaciocutaneous syndrome. The diagnosis is purely clinical and life expectancy is similar to that of the general population if the disease is not very severe.  Objective: To describe the clinical case of a patient with Noonan syndrome and an updated review of its clinical presentation, diagnosis and clinical management.  Material and methods: An exhaustive review of scientific articles was performed, consulting PUBMED, ELSEVIER, SCIELO, SCIENCE DIRECT, MEDSCAPE, REVISTA ECUATORIANA DE PEDIATRIA databases, mostly from 2017, in Spanish and English languages. Full articles and clinical case reviews were reviewed. Results: 20 articles were selected. Review articles, observational studies, descriptive, retrospective, clinical cases, clinical practice guidelines. A descriptive study was carried out for the presentation of a clinical case corresponding to Noonan syndrome. The case is presented of a 2-month-old male patient who is brought to the consultation for presenting palpebral ptosis and short stature, is evaluated by genetics resulting in a characteristic facie reminiscent of Noonan syndrome and the diagnosis is confirmed by molecular tests, laboratory tests and follow-up appointments are also performed.  Conclusions: Noonan syndrome is characterized by a typical triad including typical facial phenotype, congenital heart disease and short stature. The diagnosis is entirely clinical so primary care physicians should be properly trained to raise suspicion of possible NS and can be established by Van Der Burgt criteria although genetic testing can help in risk assessment and therapeutic management should be individualized according to age and prognosis will depend on the severity of presenting signs and symptoms. 

Uterine myomatosis is the most frequent benign neoplasm in women, but it is also an underdiagnosed pathology because it generally does not generate symptoms, occurring in 25% of women in the reproductive stage and 70% in the postmenopausal stage. The objective of this work is to present a clinical case of a patient in the menopausal stage, who debut a large nascent submucosal fibroid with septic characteristics, its management and clinical evolution. Materials and Methods: A retrospective descriptive study was performed, presenting a clinical case. The informed consent of the patient was requested for review of clinical history and images that contributed to the development of the present research. Results :describes the case of a 48-year old nuligestal female patient who presented a large nascent submucosal fibroid, so total abdominal hysterectomy plus bilateral salpingo-oforentomia is performed, obtaining a myomatous uterus of septic characteristics that generated a complicated postoperative evolution. Conclusion: it is important to make an adequate and timely diagnosis, a correct medical history, know the genetic desires or not of the patient, the age at which she is, the size of the fibroid or fibroids, its location,take into consideration and be prepared to treat the most frequent complications.

ABSTRACT Keratolysis Punctata: ¿Pathology or physical condition?, quaternary prevention and medicalization Context:Punctate keratolysis is a superficial bacterial infection of the epidermis, conditioned by different factors. Objective: Determine the frequency of keratolysis punctata in the rural pediatric population and the factors that predispose to this pathology, in order to prevent its propagation and social stigmatization. Design: Observational, descriptive cross-sectional study. Place and subjects: A total of 20 children between the ages of 6 and 12, from the “Espiga de Oro” indigenous community at the Orlando Perón School, Cayambe – Ecuador (at 3600 masl). Main measurements: Clinical history, interview, visual observation, dermoscopy and photographic record. Results: Hyperpigmentation and keratosis demonstrated by dermoscopy was found in 100% of the children. While the clinical triad represented by mild humidity in 55%, mild bromhidrosis in 70% and moderate erosion in 50%, were the most evident manifestations. Conclusion: Its diagnosis is fundamentally clinical and can be confused with fungal pathologies that delay its treatment. There are environmental and occupational conditions that predispose to these superficial lesions on the feet, their timely identification prevents their expansion and segregation.

Introduction: Tuberculosis is an infectious disease produced by Mycobacterium Tuberculosis, and has become a worldwide Public Health problem, affecting young adults and at-risk populations such as people with low socioeconomic resources and infected with human immunodeficiency (HIV), diabetes among others. Breast tuberculosis is an infrequent pathology and difficult to diagnose because it is often confused with abscesses, breast cancer or other granulomatous disease. Objective. To describe a clinical case of a female patient with extrapulmonary breast tuberculosis. Material and Method. Descriptive and retrospective study, presentation of a clinical case of a female patient with extrapulmonary breast tuberculosis attended at the Cevallos Health Center. Results. The case of a female patient with extrapulmonary breast tuberculosis treated at the Cevallos Health Center is described. Discussion. Breast tuberculosis is a very infrequent pathology, at first sight the probable diagnoses are carcinoma or abscesses, but it can be breast tuberculosis and by taking this pathology into account and requesting histopathological studies that will help to confirm the diagnosis we can quickly start the treatment of the patients. Conclusion. It is concluded that when being in front of a female patient with ulcerated and exudative nodular lesions, breast tuberculosis should be considered within the differential diagnosis, especially if the patient is of reproductive age and has not improved after the use of antibiotics.

Introduction Osteochondrial knee lesions consist of a localized anomaly that affects the subcondral marrow, the subcondral bone and the articular cartilage, are a clinical challenge, mainly in young patients. The pains present in this group of patients greatly affect their quality of life, limiting their physical activity and osteomuscular development. Currently there are surgical techniques that can remedy these disorders, improving the lifestyle of patients.Objectives: to describe two clinical cases of osteochondral knee injuries due to overuse in adults, and to determine the most current therapeutic surgical techniques.Materials and methods: A descriptive, retrospective study is performed to present clinical cases, informed consent is obtained from the teaching and research department , for review of clinical history and images that will be used in the publication of this work.Discussion: We present two clinical cases of patients who develop osteochondrial lesions of the knee, which are diagnosed and operated on by performing knee arthroscopy affects, and whose long-term results have not been entirely satisfactory, so it would merit performing cartilage restoration procedures, using microfracture techniques and autologous transplantation.Conclusions: osteochondrial lesions are common disorders in athletes, currently we have diagnostic and therapeutic techniques such as knee arthroscopy, but the application of other techniques such as microfracture and autologous transplantation for cartilage renewal should be considered a gold standard and thus be able to provide symptomatic relief improving the quality of life by repairing the surface of the articular cartilage

Introduction: In December 2019, the SARS-CoV-2 virus responsible for the COVID 19 infection was identified. In Ecuador, 922.166 infections and 35,754 deaths related to the coronavirus have been reported to date. Methodology: The objective of this study was to determine the current situation of patients confirmed with SARS COV 2 infection, in a primary care unit in the province of Cotopaxi. It was a descriptive and cross-sectional study that included 121 patients from the San Buenaventura Health Center diagnosed with COVID 19 through the polymerase chain reaction (PCR) test, the confirmed cases were grouped by sex, age group and according to the symptoms present at the time of diagnosis. All suspected patients and contacts of confirmed patients who did not have PCR, as well as those who did not have complete informative data, were excluded. Results and Discussion: Of the 121 patients confirmed with SARS COV 2 infection: 60.4% were men and 39.6% women, the age group with the greatest impact was between 20 to 64 years, in relation to comorbidities it was found to obesity (13.2%) as the main risk factor, only 12.4% were asymptomatic and within the symptoms presented by this group of patients in order of prevalence was fever (30.6%), followed by odynophagia (21.5%), other dermatological (1.7%) and gastrointestinal (5.8%) symptoms that were infrequent. In primary care, patients with SARS COV 2 infection can present a wide spectrum of symptoms, ranging from asymptomatic symptoms to very flowery and specific symptoms, such as severe respiratory symptoms described in the literature, which are a reason for timely referral to more complex units. for your assistance. Conclusion: It should be noted that this study carried out at the beginning of the pandemic was essential to keep a real epidemiological statistics of the cases of covid 19 in primary care, allowing the reinforcement of prevention measures, biosecurity at the community level and avoiding the rate of fatal events.

Introduction: Percutaneous tracheostomy by dilation (TPD) is a current procedure in the critical care unit (ICU), which is performed in patients intubated and connected to mechanical ventilation, was first described in 1985 by Ciaglia et al, as a technique, which at the moment has evolved with the incorporation of fibrobronchoscopy and ultrasound of the airway during the procedure, as well as by the development of a wide variety of devices available for its realization. It is a minimally invasive method, which serves to establish an artificial airway, by placing a tracheostomo. General objective: To evaluate the usefulness of percutaneous tracheostomy in critical care. Specific objectives. Describe the percutaneous tracheostomy technique in critical care. Determine the main indications and contraindications of percutaneous tracheostomy in critical care. Materials and methods : A review of current scientific articles obtained from databases of high prestige and international recognition such as Pubmed, critical care journals: critical care, JAMA, British journal of anaesthesia, Chest, review of data from observational studies, randomized controlled trials, meta-analysis, systematic review of the literature, guidelines, descriptive studies, retrospective studies and opinions of authors on the subject: percutaneous tracheostomy by dilation, with selection of 33 articles, in their vast majority of the last 5 years. Results: The main indication of percutaneous tracheostomy performed in intensive care unit is for patients with intubation and prolonged mechanical ventilation, to avoid the formation of: tracheomalacia, tracheal stenosis, infections associated with the tube, mechanical ventilator-associated pneumonia, among other disorder. Conclusions: It is concluded that PDT is a nonemergent technique, very useful in the patient critical in mechanical ventilation, who has a prolonged intubation and requires the performance of this procedure, to avoid complications and has been shown to decrease mechanical ventilation time and stay time in the intensive care area, providing benefit to the intubated patient to be disconnected from ventilatory support early.